Prevalence of Post-Traumatic Stress Disorder among Intensive Care Unit Survivors: A Prospective Study in Rasht, Iran
,
Abstract
Background: Post-traumatic stress disorder (PTSD) is a psychological disorder resulting from a previous
traumatic experience. The objective of the present study was to investigate the prevalence of PTSD and its related risk factors among Intensive Care Unit (ICU) survivors.
Methods: A total of 152 patients were followed up prospectively for one month. All included participants had
Glasgow Coma Scale scores ranging from 12 to 15. PTSD was assessed using a Persian-translated version of the
PTSD Checklist (PCL). Data were analyzed using SPSS 22.0 software.
Results: Among the participants, seventy-two (47.4%) men and eighty (52.6%) women with a mean age of 54.5
± 19.19 years responded to the questionnaire. The prevalence of post-discharge PTSD was 87.5%. There was
a significant correlation between PTSD mean score and clinical factors such as hospitalization reason, self and
familial history of psychological disorders, and Richmond Agitation Sedation Score (RASS) (p < 0.05).
Conclusions: Our findings suggest that, despite often being ignored, post-discharge PTSD is a significant
psychological issue for ICU survivors. This highlights the importance of supportive care plans for patients with
a history of mental disorders and agitation. The involvement of psychotherapists is crucial to improving postdischarge quality of life.
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3. Maercker A, Cloitre M, Bachem R, Schlumpf YR, Khoury B, Hitchcock C, et al. Complex post-traumatic stress disorder.Lancet. 2022 Jul 2;400(10345):60-72. https://doi.org/10.1016/ S0140-6736(22)00821-2
4. Seaman JB, Cohen TR, White DB. Reducing the stress on clinicians working in the ICU. JAMA. 2018 Nov 20;320(19):1981-2. https://doi.org/10.1001/jama.2018.14285
5. Petrinec AB, Daly BJ. Post-traumatic stress symptoms in post-ICU family members: review and methodological challenges. West J Nurs Res. 2016 Jan;38(1):57-78. https:// doi.org/10.1177/0193945914544176
6. Beesley SJ, Hopkins RO, Holt-Lunstad J, Wilson EL, Butler J, Kuttler KG, et al. Acute physiologic stress and subsequent anxiety among family members of ICU patients. Crit Care Med. 2018 Feb 1;46(2):229-35. https://doi.org/10.1097/ CCM.0000000000002835
7. Kotfis K, Marra A, Ely EW. ICU delirium-a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther. 2018 Jan 1;50(2). https://doi.org/10.5603/AIT. a2018.0011
8. Herling SF, Greve IE, Vasilevskis EE, Egerod I, Mortensen CB, Møller AM, et al. Interventions for preventing intensive care unit delirium in adults. Cochrane Database Syst Rev. 2018(11). https://doi.org/10.1002/14651858.CD009783.pub2
9. Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008 Sep 1;30(5):421-34. https://doi.org/10.1016/j. genhosppsych.2008.05.006
10. Griffiths J, Fortune G, Barber V, Young JD. The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med. 2007 Sep;33:1506-18. https://doi.org/10.1007/s00134-007-0730-z
11. Righy C, Rosa RG, da Silva RT, Kochhann R, Migliavaca CB, Robinson CC, et al. Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis. Crit Care. 2019 Dec;23:1-3. https:// doi.org/10.1186/s13054-019-2489-3
12. Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a meta-analysis. Crit Care Med. 2015 May 1;43(5):1121-9. https://doi.org/10.1097/ CCM.0000000000000882
13. Calsavara AJ, Costa PA, Nobre V, Teixeira AL. Prevalence and risk factors for post-traumatic stress, anxiety, and depression in sepsis survivors after ICU discharge. Braz J Psychiatry. 2020 Oct 7;43:269-76. https://doi.org/10.1590/1516-4446- 2020-0986
14. Sareen J, Olafson K, Kredentser MS, Bienvenu OJ, Blouw M, Bolton JM, et al. The 5-year incidence of mental disorders in a population-based ICU survivor cohort. Crit Care Med. 2020 Aug 1;48(8):e675-83. https://doi.org/10.1097/ CCM.0000000000004413
15. Da Costa JB, Taba S, Scherer JR, Oliveira LL, Luzzi KC, Gund DP, et al. Psychological disorders in post-ICU survivorsand impairment in quality of life. Psychol Neurosci. 2019 Sep;12(3):391. https://doi.org/10.1037/pne0000170
16. Vogt D, Smith BN, Fox AB, Amoroso T, Taverna E, Schnurr PP. Consequences of PTSD for the work and family quality of life of female and male US Afghanistan and Iraq War veterans. Soc Psychiatry Psychiatr Epidemiol. 2017 Mar;52:341-52. https://doi.org/10.1007/s00127-016-1321-5
17. Benfer N, Litz BT. Assessing and addressing functioning and quality of life in PTSD. Curr Treat Options Psychiatry. 2023 Mar;10(1):1-20. https://doi.org/10.1007/s40501-023-00284-8
18. Myhren H, Ekeberg O, Toien K, Karlsson S, Stokland O. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care. 2010;14(1):R14. https://doi.org/10.1186/cc8870
19. Namigar T, Serap K, Esra AT, Özgül O, Can ÖA, Aysel A, et al. The correlation among the Ramsay sedation scale, Richmond agitation sedation scale and Riker sedation agitation scale during midazolam-remifentanil sedation. Rev Bras Anestesiol. 2017 Jul;67:347-54. https://doi.org/10.1016/j. bjane.2016.07.002
20. Goudarzi MA. Validation and reliability of the Mississippi Scale for Posttraumatic Stress. J Psychol. 2003;2(7):153-77.
21. Sadat Z, Abdi M, Aghajani M. Prevalence of Posttraumatic Stress Disorder and Related Factors Among Patients Discharged From Critical Care Units in Kashan, Iran. Arch Trauma Res. 2015 Nov 1;4(4):e28466. https://doi.org/10.5812/atr.28466
22. Salimi Y, Hoeboer C, Motevalli Haghi SA, Williamson RE, Rahimi MD, Rajabi-Gilan N, et al. Trauma and its consequences in Iran: cross-cultural adaption and validation of the Global Psychotrauma Screen in a representative sample. BMC Psychiatry. 2023 Jan 25;23(1):65. https://doi. org/10.1186/s12888-023-04564-8
23. Ratzer M, Brink O, Knudsen L, Elklit A. Posttraumatic stress in intensive care unit survivors - a prospective study. Health Psychol Behav Med. 2014 Jan 1;2(1):882-98. https://doi.org/1 0.1080/21642850.2014.943760
24. Nickel M, Leiberich P, Nickel C, Tritt K, Mitterlehner F, Rother W, Loew T. The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample. J Intensive Care Med. 2004 Sep- Oct;19(5):285-90. https://doi.org/10.1177/0885066604267684
25. Friberg K, Hofsø K, Ræder J, Rustøen T, Småstuen MC, Olsen BF. Prevalence of and predictive factors associated with high levels of post-traumatic stress symptoms 3 months after intensive care unit admission: a prospective study. Aust Crit Care. 2024 Mar 1;37(2):222-9. https://doi.org/10.1016/j. aucc.2023.06.005
26. Valsø Å, Rustøen T, Skogstad L, Schou-Bredal I, Ekeberg Ø, Småstuen MC, et al. Post-traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge. Nurs Crit Care. 2020 Mar;25(2):117-25. https://doi. org/10.1111/nicc.12466
27. Khitab A, Reid J, Bennett V, Adams GC, Balbuena L. Late onset and persistence of post-traumatic stress disorder symptoms in survivors of critical care. Can Respir J. 2013 Nov-Dec;20(6):429-33. https://doi.org/10.1155/2013/861517
28. Scragg P, Jones A, Fauvel N. Psychological problems following ICU treatment. Anaesthesia. 2001;56(1):9-14. https://doi.org/10.1046/j.1365-2044.2001.01714.x
29. Rattray JE, Johnston M, Wildsmith JA. Predictors of emotional outcomes of intensive care. Anaesthesia. 2005;60(11):1085- 92. https://doi.org/10.1111/j.1365-2044.2005.04336.x
30. Girard TD, Shintani AK, Jackson JC, Gordon SM, Pun BT, Henderson MS, et al. Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Crit Care. 2007;11(1):R28. https://doi.org/10.1186/cc5708
31. Capuzzo M, Valpondi V, Cingolani E, Gianstefani G, De Luca S, Grassi L, et al. Post-traumatic stress disorder related symptoms after intensive care. Minerva Anestesiol. 2005;71(4):167-79.
32. Breslau N, Anthony JC. Gender differences in the sensitivity to posttraumatic stress disorder: an epidemiological study of urban young adults. J Abnorm Psychol. 2007;116(3):607-11. https://doi.org/10.1037/0021-843X.116.3.607
33. Davydow DS, Zatzick DF, Rivara FP, Jurkovich GJ, Wang J, Roy-Byrne PP, et al. Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors. Gen Hosp Psychiatry. 2009;31(5):428-35. https://doi.org/10.1016/j. genhosppsych.2009.05.007
34. de Wit M, Wan SY, Gill S, Jenvey WI, Best AM, Tomlinson J, et al. Prevalence and impact of alcohol and other drug use disorders on sedation and mechanical ventilation: a retrospective study. BMC Anesthesiol. 2007;7:3. https://doi. org/10.1186/1471-2253-7-3
35. Paparrigopoulos T, et al. Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: a two-year follow-up study. Int J Psychiatry Clin Pract. 2014;18(1):25-31. https:// doi.org/10.3109/13651501.2013.855793
2. Bryant RA. Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges. World Psychiatry. 2019 Oct;18(3):259-69. https://doi.org/10.1002/wps.20656
3. Maercker A, Cloitre M, Bachem R, Schlumpf YR, Khoury B, Hitchcock C, et al. Complex post-traumatic stress disorder.Lancet. 2022 Jul 2;400(10345):60-72. https://doi.org/10.1016/ S0140-6736(22)00821-2
4. Seaman JB, Cohen TR, White DB. Reducing the stress on clinicians working in the ICU. JAMA. 2018 Nov 20;320(19):1981-2. https://doi.org/10.1001/jama.2018.14285
5. Petrinec AB, Daly BJ. Post-traumatic stress symptoms in post-ICU family members: review and methodological challenges. West J Nurs Res. 2016 Jan;38(1):57-78. https:// doi.org/10.1177/0193945914544176
6. Beesley SJ, Hopkins RO, Holt-Lunstad J, Wilson EL, Butler J, Kuttler KG, et al. Acute physiologic stress and subsequent anxiety among family members of ICU patients. Crit Care Med. 2018 Feb 1;46(2):229-35. https://doi.org/10.1097/ CCM.0000000000002835
7. Kotfis K, Marra A, Ely EW. ICU delirium-a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther. 2018 Jan 1;50(2). https://doi.org/10.5603/AIT. a2018.0011
8. Herling SF, Greve IE, Vasilevskis EE, Egerod I, Mortensen CB, Møller AM, et al. Interventions for preventing intensive care unit delirium in adults. Cochrane Database Syst Rev. 2018(11). https://doi.org/10.1002/14651858.CD009783.pub2
9. Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008 Sep 1;30(5):421-34. https://doi.org/10.1016/j. genhosppsych.2008.05.006
10. Griffiths J, Fortune G, Barber V, Young JD. The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med. 2007 Sep;33:1506-18. https://doi.org/10.1007/s00134-007-0730-z
11. Righy C, Rosa RG, da Silva RT, Kochhann R, Migliavaca CB, Robinson CC, et al. Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis. Crit Care. 2019 Dec;23:1-3. https:// doi.org/10.1186/s13054-019-2489-3
12. Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a meta-analysis. Crit Care Med. 2015 May 1;43(5):1121-9. https://doi.org/10.1097/ CCM.0000000000000882
13. Calsavara AJ, Costa PA, Nobre V, Teixeira AL. Prevalence and risk factors for post-traumatic stress, anxiety, and depression in sepsis survivors after ICU discharge. Braz J Psychiatry. 2020 Oct 7;43:269-76. https://doi.org/10.1590/1516-4446- 2020-0986
14. Sareen J, Olafson K, Kredentser MS, Bienvenu OJ, Blouw M, Bolton JM, et al. The 5-year incidence of mental disorders in a population-based ICU survivor cohort. Crit Care Med. 2020 Aug 1;48(8):e675-83. https://doi.org/10.1097/ CCM.0000000000004413
15. Da Costa JB, Taba S, Scherer JR, Oliveira LL, Luzzi KC, Gund DP, et al. Psychological disorders in post-ICU survivorsand impairment in quality of life. Psychol Neurosci. 2019 Sep;12(3):391. https://doi.org/10.1037/pne0000170
16. Vogt D, Smith BN, Fox AB, Amoroso T, Taverna E, Schnurr PP. Consequences of PTSD for the work and family quality of life of female and male US Afghanistan and Iraq War veterans. Soc Psychiatry Psychiatr Epidemiol. 2017 Mar;52:341-52. https://doi.org/10.1007/s00127-016-1321-5
17. Benfer N, Litz BT. Assessing and addressing functioning and quality of life in PTSD. Curr Treat Options Psychiatry. 2023 Mar;10(1):1-20. https://doi.org/10.1007/s40501-023-00284-8
18. Myhren H, Ekeberg O, Toien K, Karlsson S, Stokland O. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care. 2010;14(1):R14. https://doi.org/10.1186/cc8870
19. Namigar T, Serap K, Esra AT, Özgül O, Can ÖA, Aysel A, et al. The correlation among the Ramsay sedation scale, Richmond agitation sedation scale and Riker sedation agitation scale during midazolam-remifentanil sedation. Rev Bras Anestesiol. 2017 Jul;67:347-54. https://doi.org/10.1016/j. bjane.2016.07.002
20. Goudarzi MA. Validation and reliability of the Mississippi Scale for Posttraumatic Stress. J Psychol. 2003;2(7):153-77.
21. Sadat Z, Abdi M, Aghajani M. Prevalence of Posttraumatic Stress Disorder and Related Factors Among Patients Discharged From Critical Care Units in Kashan, Iran. Arch Trauma Res. 2015 Nov 1;4(4):e28466. https://doi.org/10.5812/atr.28466
22. Salimi Y, Hoeboer C, Motevalli Haghi SA, Williamson RE, Rahimi MD, Rajabi-Gilan N, et al. Trauma and its consequences in Iran: cross-cultural adaption and validation of the Global Psychotrauma Screen in a representative sample. BMC Psychiatry. 2023 Jan 25;23(1):65. https://doi. org/10.1186/s12888-023-04564-8
23. Ratzer M, Brink O, Knudsen L, Elklit A. Posttraumatic stress in intensive care unit survivors - a prospective study. Health Psychol Behav Med. 2014 Jan 1;2(1):882-98. https://doi.org/1 0.1080/21642850.2014.943760
24. Nickel M, Leiberich P, Nickel C, Tritt K, Mitterlehner F, Rother W, Loew T. The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample. J Intensive Care Med. 2004 Sep- Oct;19(5):285-90. https://doi.org/10.1177/0885066604267684
25. Friberg K, Hofsø K, Ræder J, Rustøen T, Småstuen MC, Olsen BF. Prevalence of and predictive factors associated with high levels of post-traumatic stress symptoms 3 months after intensive care unit admission: a prospective study. Aust Crit Care. 2024 Mar 1;37(2):222-9. https://doi.org/10.1016/j. aucc.2023.06.005
26. Valsø Å, Rustøen T, Skogstad L, Schou-Bredal I, Ekeberg Ø, Småstuen MC, et al. Post-traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge. Nurs Crit Care. 2020 Mar;25(2):117-25. https://doi. org/10.1111/nicc.12466
27. Khitab A, Reid J, Bennett V, Adams GC, Balbuena L. Late onset and persistence of post-traumatic stress disorder symptoms in survivors of critical care. Can Respir J. 2013 Nov-Dec;20(6):429-33. https://doi.org/10.1155/2013/861517
28. Scragg P, Jones A, Fauvel N. Psychological problems following ICU treatment. Anaesthesia. 2001;56(1):9-14. https://doi.org/10.1046/j.1365-2044.2001.01714.x
29. Rattray JE, Johnston M, Wildsmith JA. Predictors of emotional outcomes of intensive care. Anaesthesia. 2005;60(11):1085- 92. https://doi.org/10.1111/j.1365-2044.2005.04336.x
30. Girard TD, Shintani AK, Jackson JC, Gordon SM, Pun BT, Henderson MS, et al. Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Crit Care. 2007;11(1):R28. https://doi.org/10.1186/cc5708
31. Capuzzo M, Valpondi V, Cingolani E, Gianstefani G, De Luca S, Grassi L, et al. Post-traumatic stress disorder related symptoms after intensive care. Minerva Anestesiol. 2005;71(4):167-79.
32. Breslau N, Anthony JC. Gender differences in the sensitivity to posttraumatic stress disorder: an epidemiological study of urban young adults. J Abnorm Psychol. 2007;116(3):607-11. https://doi.org/10.1037/0021-843X.116.3.607
33. Davydow DS, Zatzick DF, Rivara FP, Jurkovich GJ, Wang J, Roy-Byrne PP, et al. Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors. Gen Hosp Psychiatry. 2009;31(5):428-35. https://doi.org/10.1016/j. genhosppsych.2009.05.007
34. de Wit M, Wan SY, Gill S, Jenvey WI, Best AM, Tomlinson J, et al. Prevalence and impact of alcohol and other drug use disorders on sedation and mechanical ventilation: a retrospective study. BMC Anesthesiol. 2007;7:3. https://doi. org/10.1186/1471-2253-7-3
35. Paparrigopoulos T, et al. Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: a two-year follow-up study. Int J Psychiatry Clin Pract. 2014;18(1):25-31. https:// doi.org/10.3109/13651501.2013.855793
| Files | ||
| Issue | Vol 7 No 4 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ajs.v7i4.17467 | |
| Keywords | ||
| Post-Traumatic Stress Disorder; Intensive Care Unit; Trauma; ICU Survivors | ||
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How to Cite
1.
Sedadi P, Ashraf A, Pourramazni A, Zareh R. Prevalence of Post-Traumatic Stress Disorder among Intensive Care Unit Survivors: A Prospective Study in Rasht, Iran. AJS. 2025;7(4):113-118.
